Frequently Asked Questions
What is the WiseChoice Healthcare Alliance?
The WiseChoice Healthcare Alliance was created by the Virginia Chamber of Commerce for the purpose of offering employer-based group insurance to members of affiliated local chambers and associations. The alliance offers a self- funded employee welfare benefit plan to eligible employer groups with 2–50 employees. The alliance has partnered with Anthem to provide a portfolio of health benefit options, labeled the WiseChoice Healthcare Alliance. The program has been granted operating authority and is regulated by the Virginia Bureau of Insurance.
Which businesses are eligible to participate?
The WiseChoice Healthcare Alliance plans are available to employers who are members of the WiseChoice Healthcare Alliance and who:
- Have 2 to 50 employees enrolled in their medical plan
- Have their corporate headquarters located in Anthem’s service area.
- Are in good standing with their participating chamber or affiliated association.
Why choose the WiseChoice Healthcare Alliance plan over an ACA plan?
The mission of the alliance is to connect like-minded small businesses who are ready to be actively engaged in managing their healthcare costs through member engagement, wellness programs, and lower-cost digital care options. By being part of a self-funded group, your business shares overall claims risk with other small businesses, and also shares the costs for financial protection provided by stop-loss coverage.
Being part of a larger group also gives a business access to competitive, predictable rates and quality benefits through one of the largest national healthcare networks. In addition, expanded access to innovative tools, programs, and services empowers employees to make more informed healthcare decisions that can improve their health, and can lower overall group healthcare costs. The success of the program depends on the active engagement of the participating employer groups.
Do businesses need to meet certain participation and contribution requirements?
Yes. Like most other small business health plans, at least 75% of eligible employees, excluding valid waivers and a minimum of two employees, must be covered under the plan.
The plan also requires employer contribution of at least 50% of the employee rate for individual benefits of the lowest- cost plan offered.
Can a business join the WiseChoice Healthcare Alliance at any time during the year?
Absolutely. An eligible employer may join the WiseChoice Healthcare Alliance and purchase a plan at any time. Renewals for participating businesses occur at different times of the year. A group’s renewal date is based on the group’s original effective date.
Are dental, vision, life, and disability options available?
Yes. Participating employers in the WiseChoice Healthcare Alliance are eligible for other plans offered by Anthem at a discounted rate. These are stand-alone, fully insured plans for which the participating employer contracts directly with Anthem.
ARE SMALL BUSINESS BENEFITS CONSORTIUMS A NEW CONCEPT?
No, highly similar small business benefits consortiums are operational elsewhere. Plans in Ohio, Missouri, Indiana, and Georgia have realized 15-20% cost savings for participating small businesses.
WILL BENEFITS CONSORTIUMS UNDER THE PROPOSED LEGISLATION DISCRIMINATE BASED ON HEALTH STATUS?
No, this is prohibited. Benefits consortiums – and their sponsoring association – are prohibited from establishing discriminatory rules based on health status related to eligibility, premium, or contribution requirements.
WILL OLDER WORKERS BE ADVERSELY IMPACTED BY THESE BENEFITS CONSORTIUMS?
Absolutely not. In fact, older workers will likely benefit from the rating methodology that benefits consortiums will likely use. Benefits consortiums normally utilize what is known as “composite rates” whereby each employee within the specific employer group – regardless of age – has the same rate if they are enrolled in the same tier of coverage e.g. self, self + child, self + spouse, and family.
WILL BENEFITS CONSORTIUMS COVER PRE-EXISTING CONDITIONS?
Yes. Pre-existing conditions must be covered. Benefits consortiums are subject to the same rules as all other small group ACA compliant plans. As such, they cannot impose a pre-existing condition exclusion on individuals or groups.
WILL BENEFITS CONSORTIUMS OFFER COMPREHENSIVE COVERAGE?
Yes. Benefits consortiums are required to provide quality comprehensive coverage. In fact, minimum acceptable coverage must include all ACA-compliant Essential Health Benefits, must meet the ACA’s definition of Minimum Essential Coverage, and all plans offered must meet or exceed a 60% actuarial value (equivalent to an ACA Bronze plan).
ARE THESE NEW BENEFITS CONSORTIUMS FINANCIALLY STRONG?
Yes. These bills require benefits consortiums to have the same solvency requirements as insurers domiciled in Virginia (termed as a Domestic Insurer). Moreover, benefits consortiums also provide employer and individual financial security using reinsurance and terminal liability provisions.
WHO HAS REGULATORY AUTHORITY OF THESE BENEFITS CONSORTIUMS?
Virginia’s Bureau of Insurance (BOI) has full licensing and regulatory authority as well as oversight related to financial and solvency requirements of all benefits consortiums. Additionally, as a Multiple Employer Welfare Arrangement (MEWA), benefits consortiums are subject to United States Department of Labor oversight under The Employee Retirement Income Security Act of 1974 (ERISA).
WHO OVERSEES THE BENEFITS CONSORTIUM?
Benefits consortiums are operated by member-managed trusts that oversee each plan’s set-up and operations. These member-managed trusts are required to use all funds for the benefit of participating employees and their dependents.
WILL BENEFITS CONSORTIUMS HURT THE NEW STATE-BASED EXCHANGE?
Benefits consortium plans are not in direct competition with Virginia’s state-based exchange for the ACA individual market. Because shifts into the consortium occur at the group level, rather than at the individual level, self-selection by an individual employee is much more difficult.
DO BENEFITS CONSORTIUMS SEGMENT THE EXISTING SMALL GROUP MARKET?
Benefits consortiums do not target “low risk” groups for participation and do not seek to segment the existing small group market. These bills provide that any small employer, regardless of risk, may participate. Additionally, the sponsoring association cannot condition membership on health status thereby further reducing the opportunity for segmentation. As a result, it is expected that benefits consortiums will enroll a broad cross-section of risk – not just lower-risk employers.
WILL ALL PARTICIPATING SMALL BUSINESSES HAVE THE SAME RATE?
No, each employer group will have its own unique rates. Benefits consortiums will establish base rates formed on an actuarially sound, modified community rating methodology that considers the pooling of all participant claims. Once this base rate is established, each employer group’s specific risk profile is used to determine rates by actuarially adjusting above or below the established base rates.
DOES EACH EMPLOYEE HAVE A DIFFERENT RATE WITHIN THEIR EMPLOYER GROUP?
No, like most large employers, benefits consortiums normally utilize what is known as “composite rates” whereby – regardless of age, health history, sex, or smoker status – each employee within the specific employer group has the same rate if they are enrolled in the same tier of coverage e.g. self, self + child, self + spouse, and family.
CAN BENEFITS CONSORTIUMS PROVIDE CUSTOMIZED COVERAGE?
Yes, because benefits consortiums are member-managed trusts that oversee each plan’s set-up and operations, they have the authority and ability to design plan attributes that are unique to a particular demographic, a specific geographic area, a given industry, or community.
